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HomeMy WebLinkAbout03-10-1015056051047 REV-15 00 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 ~ a ~ ' O ~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name Suffix Decedent's First Name MI C~~ r ~S 1`~r ~e~ter (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death bet~~reen 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ n ~ ~ ~ ~- ~-~ q m ~F C ~ ~7 ~ 7 ~ ~ 1 4 4~3 y ~ Firm Name (If Applicable) First line of address ~ ~ u t. ~ ~R ~ n C t, Second line of address City or Post Office State Ivl ~ _c h ~- n -~ ~ ~ ~ u. r ~ ~ Correspondent's a-mail address: ZIP Code REGISTE~F WILLS USVLY C Q r:.a __~ r ~ ~ ~ ~- ~ ~ ~~ ~ ~~ r ~Fj ~i~ . _. 1. ,l jl ~ ~ ~~ (, ; ,1 ~~ ~~~ ~TE~ILED V •• ..; 17o.~v _..-_;x -, ,~ i ..- c ~ :~ `i 'T""I -ti} j_„~.: f ~~ 1 _ `~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE O ERSO ESPONSIBLE FILING TURN DATE _ / ` ~ O ADDRESS // U C,t ~ . E' ~ ~./'1l ltr l ~7 ~ J`~Q SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~~ ~ 1. ~'r ~~' ~ ~ ~ ~ ' RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. • 2. Stocks and Bonds (Schedule B) ....................................... 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. " Q 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 3 ~ ~ ~ • Q 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. + /. 8. Total Gross Assets (total Lines 1-7) .................................... 8. ~, ~ ~' ~ • U 7 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. • ~'~~l 8~ 11. Total Deductions (total Lines 9 & 10) ................................... 11. ~`) , ~ -- • 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................... ..... 13. ~- 14. ............. Net Value Subject to Tax (Line 12 minus Line 13) ...... .....14. ~~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ . 15. 16. Amount of Line 14 taxable at lineal rate X .0 ~ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 +~ 18. • 19. TAX DUE ......................................................... 19. _ ~ -~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 15056052048 J • REV-1500 EX Page 3 File Number r~ Decedent's Complete Address: G- ~ ~ ~~ (~ ~~~j DECEDENT'S NAME- L~L~~~r ~1~~ ~r~~~~ __ STREET ADDRESS ~ ~ L~ ~ I 1 1 ~.{ ~~ _~ CITY _ _ _ _ _STATE i ZIP _ _ ~~~2~~C~~u.r ~~ I7v ~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit _ _ __ B. Prior Payments _. __ C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .............................................:............................................................................ ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)j. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. -+~v,sodbc.{,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF pp C~'~-~-~Ir ~~Q-~ ~ ~~r ~~ FILE NUMBER ~~ ~ 1JO ~~ lndude the prnoeeds of Iib'gatan and the date the proceeds ~e t~eoeiMed hY the estate. Ad property joiMh-~wned with fhe right of wrvivashy~ mint be discbsed on Schedule F. ITEM NUMBER VALUE AT DATE ASCRIPTION OF DEATH ~cc-~.~ ~ oao~~~- $ ~~ 9 E• `Nla~n SF. ~P-~~ ~oX -ooo V-F~tz, ~A ~~543 TOTAL (Also enter on line 5, Recapitulation) ~ ; ~ 2..1p ~ ~ O ff more ( spy ~s needed, utsert addlhonal streets of the same s¢e) REV-1611 EX+ (12-99) SCNEdt~ILE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~c INHERITANCE TAX RETURN ADMiNISTRATNE COSTS RESIDENT DECEDENT ESTATE OF o -_- L~T~„~- ~. Q~-t~ FILE NUMBER ~~ ~~~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State ~ Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's addn3ss is not th/~e same as daimant's, attach explanation) Claimant ~YN~~'~ L'' A~ `~ Street Address S ~' ~~- /~+ "'I ~~ City I~~>-~d,~s j c"- State ~ t-ld~d Relationship of Claimant to Decedent ~W ~~~ 4. I Probate Fees 5. I Accountant's Fees 6. ~ Tax Return Preparer's Fees 7 3,z~~. s~ TOTAL (Also enter on fine 9, Recapitulation) I ~ ~ ~ 1 (If more space is needed, insert additional sheets of the same size) REV 513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEpULE J BENEFICIARIES ESTATE OF FILE NUMBER ~.. ~'~-der ~c~~-~ ~ ~rr~~ 2.~a~ -~~,.~~a~ NUMBER __- NAME AND ADDRESS OF PERSONS} RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I ,. TAXABLE DISTRIBUTIONS rrr>clude outright spousal distributions, and transfers wider Sec. 9116 (a} (12)j ~~ %? o~ m~e. i ~ ~-- ~ ~©~~.f~ err%~ ~ ~ ~ ~ ~~ i G2,C ~rad~ Y .~ Neer 81ao~-die! d , ~~ ~ 10~ ~~" ~ -~ ~ Sri ~ ?~ , b ~rl 1' m Q~~ ~~ Z~ ~, ~ec~- l~l~~ ~~ ~ . , ~~~ ~ ~ ~~ 3~ ~i~ ~ . ,~~~.c~ y ' ~ ~~~ l ~ ~n ~ ~ ~ r d ~-~ ~~ ' m one ~y y ~~ ~ ,. ~~ ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II 1. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9ii3 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1500 COVER SHEET I ~ a in f. ~~r mwe space is neeaea, insert aaditional sheets of the same size) ~- WILL OF LESTER D. ORRiS I, Lester D. Orris, of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administratnre expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that ail inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate.. . 3. I direct that my entire estate be distributed as follows: A. !leave everything to my wife, Hope E. Orris. B. Should Hope E. Orris predecease me, l leave my estate in equal shares to my children, Lester D. Orris, Il, Gary S. Orris and Cynthia L. Amice. Should any of my children ~edecease me, their share shall go the surviving children. 4. I appoint my wife, Hope E. Oms as Executrix of this my last Will. If she should predecease me or cease to act in such capacity, I appoint Cynthia L. Amice as alternate. 5. The Executrix of this Will shalt have the power to distribu#e my estate in kind or in cash, or partly in either. 6. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. !N WITNESS EOF, I have hereunto set my hand this S day of , 2004 ~ .` -~- ~,v Lester D. Orris LAW OFFICES OP 'EPHEN J. NOGG S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 s_ -` ACKNOWLEDGMENT LAW OFFICES OE 'EPHEN J. HOG! S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 State of Pennsylvania County of Cumberland ss I, Lester D. Orris, the testator, whose name is signed to the attached or foregoing instrument, having been duly qualified acxording to law, do hereby acknowledge that I signed and executed the instrumen# as my last Wili; that 1 signed it willingly and as my free and voluntary act fior the purposes therein express ~ ~,., ~ 'Lester D: Oms Swom to or affirm Viand acknoy~ed fore me by Lester D. Orris, the testator, this day of (~ ~~ , 2004. NOTARIAL S~At STEPHEN .i. tK)GG, NOTAAI/ PUBLIC ~ _- ~ . CARUSL.E BORO, Ctl CO., PA MY coMM~ssION s~~R ~, 2005 No ry Public/A AFFlDAYIT State of Pennsylvania ~s .County of Cumberland We, ~~'4 7~ . 6~ 1 ~r L and ~ ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the Will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of so mind a under no constraint or undue influen ~. .. Swom to or affirmed ribed to bef re me by witnesses, this ~ day of CC..~~ 0Q4. . , f .~~~ Notary PubliciAtt NOTARIAL sEA1. STEPHEN J. IlOGStr, NOTARY PUBLIC CARLISLE BO~iO, CUMBERLAND CO., PA COMMISSION EXPIRES SEPL'EMBER 3.2005 ~,- The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Lester D. Orris, as and for his last Will in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ,, it WITNESS W NESS ~W o~~~ of TEPHEN J. NOGG t 9 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 S~ S~,.r_ ~ cep '~~ z~ . c~ ~l~ -~ ~o h~ a~`~2-